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Neuro Doctor, Neurologist (MD)

Category: Neurology

Satisfied Customers: 4071

Experience: American Board Certified Neurologist, Internal Medicine

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My right forearm began twitching 5 weeks ago. It initially

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My right forearm began twitching 5 weeks ago. It initially lasted 3 days, then quit for 2 weeks, then started up again and has continued to the present. The twitching can initiate at rest, but also occurs in response (and during) physical exertion. The severity of the twitches was rarely more than a couple of seconds. They were episodic: they might be common for a couple of hours and absent at other times. I went to my doctor this last Wednesday, and he said it was unlikely to be ALS. On Thursday, the twitch episodes increased in intensity, with twitches now exceeding 30 seconds. Also, just yesterday, a second twitch developed above my knee. This twitch is rather constant, with a dozen or so twithes occuring every 5 minutes. I have not discerned any notable weakness. Do these symptoms point to ALS...or are they common?

I am an American Board Certified Neurologist (studied & worked in USA) with a vast neurology clinical practice experience. I am familiar with the condition that you have described and can help you with your questions/concerns.

There are myriad causes for muscle twitching and based on the history you provided that it is of recent onset and no muscle weakness then ALS is unlikely!

I assume you are not on any medications now. If ‘yes' and if they were started recently then it is worth holding them for few days & see what happens(not all meds can be stopped abruptly; some of them needs to be gradually tapered off).

If excessive caffeine intake is there then reduction can help.

You have not mentioned any stress/anxiety etc, so that is a less likely possibility but if you feel these conditions may exist then treating them will help you with the twitchings too. The treatment consists of counseling/therapy, medications (like Tab Buspar, Xanax) to reduce stress etc.

Benign fasciculations as the name implies are benign in nature. But it is a rule out diagnosis, means we need to rule out other possibilities before considering this as a possibility.

ALS is unlikely with your presentation. However if the twitching do not get better, and all above investigations look ok then you need to see a clinic-neurologist to undergo a clinical examination and also an EMG (needle test). This test is highly useful to study the muscles and will provide us more insight into your condition. This test will help in ruling out ALS as well, and again ALS is unlikely possibility in your case, but these are the investigations you need with your presentation.

Sometimes symptoms come & go without any consequences, hopefully that is all you have. All the Best!

These are my opinions & recommendations based on the details provided, and if you are seeking a more elaborative discussion or have additional concerns then please ask any number of questions until you clarify all your doubts.

Does the fact that the twitch disappeared for two weeks before reappearing help confirm that this is not ALS-related? Is it significant that twitching in the forearm often is initiated -- and occurs with -- physical exertion? None of the factors you listed as causes apply, except the stress (I am a worrier!). Instead, my doctor (general practitioner) thought the onset of the twitching was related to some sort of over exertion and that the twitch has been prolonged because of constant re-irritation. (??? I'm not sure I'm stating things right.) Also, is it worrisome that the forearm twitches have been more severe in the last few days and that a second twitch has started? You seem to suggest that twitches without noticeable muscle weakness are not indicative of ALS. Period. Is this correct? Thank you for your help.

1) The twichings disappeared before reappearing is a good sign when we look at ALS possibility. With ALS the twitchings usually are continuous, even if not continuous but disappearing for about 2 weeks is very unusual.

2) Very difficult to correlate with physical exertion to twitching. It may occur if concomitant sever dehydration also exist, and that is due to electrolyte abnormalities irritating the muscle fibers. And we have already mentioned the electrolyte possibility. In my opinion physical exertion is not causing the twichings (unless you were dehydrated too).

3) If you have stress then it can trigger twichings, no doubt about it.

4) To be honest with you it is difficult to consider the twitchings are due to exertion and then a constant re-irritation. We see patients with twitches very commonly and I am not aware of that as a possibility in any of my patients. Even in books I am not aware of coming across that as a possibility

5) I agree while the reappearance of twitches will obviously concerning however recurrent twitches are seen in varieties of non-ALS conditions like stress, benign fasiculations, thyroid etc. In fact with ALS we see constant twitches rather than on and off. So that seems a sign in favor of you!

6) To be honest with you I cannot rule out ALS 100% based on 'no muscle weakness', but nearly 100% in your case based on no muscle weakness, also the recent onset, disappearing pattern etc.

So if you ask me to put all the pieces of information together and give you an estimation then in my opinion ALS is extremely less likely in your case. I also assume you have no family history of ALS (please correct me if I am wrong) and if that is true then it is very near to "zero" percent in your case.

Nevertheless I recommend you to see a clinic-neurologist as described earlier and undergo further evaluation. The blood tests may be ordered by your family Dr or the neurologist. The EMG test is done by the neurologist. And of course by the time you see them if twitches disappear permanently then no further interventions are required. All the Best!

Please ask any numbers of questions until you clarify all your doubts.

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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